The Value of Meaningful Use

There's been a recent round of headlines reflecting on the efficacy of the Meaningful Use program to push physicians and hospitals to adopt electronic health records (EHRs). A RAND study conducted in 2005 was one of the major arguments that prompted Congress to allocate tens of billions of dollars to care providers (and really, healthcare IT vendors). The study suggested that adopting healthcare IT would save billions and pay for itself, and help push medicine further faster.

There are a million ways to criticize the meaningful use program. They are probably all valid. Some of the most prominent arguments against meaningful use have been: 1) that the nature of the program rewards legacy vendors and discourages innovators 2) that meaningful use's failure proves that healthcare IT can never work 3) that we're spending enormous sums of tax payer dollars without having proved efficacy of healthcare IT 4) that the program is measuring the wrong metrics 5) that the program doesn't take into account the nuances of each medical specialty. 

All of these arguments may be valid. But even collectively, they do not provide the impetus to halt the meaningful use program. They all fail to recognize the enormous cost of stopping the healthcare IT push. Modern computing platforms have transformed every industry in the world. Healthcare is not special. Yes, it has its nuances, but fundamentally, healthcare is no different than any other industry - highly specialized individuals need to share information to make decisions and exercise their best judgement, and that highly specialized work needs to tie back into generic administrative processes (managing accounts receivable, accounting, payroll, inventory, etc). Computers have revolutionized these processes in every industry except healthcare (and education, and to some extent, retail). Computers can revolutionize healthcare too.

50 years from now, we will all look back on the late 2000-aughts and 2000-teens as the decade of experimentation in healthcare IT. There are hundreds of thousands, perhaps millions, of extremely smart and driven people trying to implement healthcare IT solutions to improve efficiency and outcomes. Everything we do in the first half of the 2000-aughts and teens may be 100% wrong. And that's ok because that's the cost of learning.

We are learning because we are wrong. We will never get to the futuristic sci-fi medicine of 2060 without making all of the mistakes that we're making today. We need to learn how to effectively design, build, and implement large and complicated administrative and clinical systems spanning hundreds of stakeholder groups and millions of care providers. Hospital management, administrators, and clinicians are all learning incredible amounts about how technology works, and how information flows can and should be in different environments and situations. No academic environment can teach the future of healthcare delivery because no one knows what it will look like yet. We have to figure it out.

Although I'm frustrated with many of the details of the meaningful use program, the calls to repeal it and stop healthcare IT installations are laughable. They take such a short-sighted, limited view of where medicine is today, where it could be, and how we'll get there. No country of scale has implemented a decentralized healthcare environment (it's relatively easy when you operate at 1/10 the scale of the US and force every doctor onto a monolithic platform that is mediocre or sub-par in every way, such as Denmark or Finland). As Americans, we're the pioneers, and we're going to make plenty of mistakes along the way. And that's why we generally out-innovate everyone else.

Americans try, fail, and learn faster and more frequently than everyone else. We always have. And that's why we have and will kick everyone else's asses in healthcare delivery. There're good reasons why almost every major technology company in the world was founded and is based in the USA. Americans take risks and figure shit out. Americans will be the leaders in informatics, data interoperability, medical research, efficient and effective care delivery because they spend tens of billions of dollars making mistakes. It may take 10 or even 20 years to pan out, but the meaningful use impetus has changed the course of healthcare delivery in this country for the better.